Problem with blood withdrawal Hickman Line

[cannulation]

I need advice our hospital policy states that before nurses can access a Hickman line for the first time blood draw must be made to ensure placement and also no problems such as a fibrin sheath. If it is a continous infusion going through blood draw would only be required once, however if it is not a continous infusion blood draw is needed each time to ensure no complications. The other day I was called to a ward to advise nurses had a new hickman line could not get blood. Treated as a fibrin sheath as could flush. Still not able to draw blood outcome consultant gave me a lecture on the fact we would never get blood from a hickman line as the line closes in on itself. The doctors therefore had to start first infusion of TPN. No complications so nurses able to change TPN and flush. Can anyone advise on why no blood draw.

[GailAnne]

First question would be, where is the tip? Is it really in distal SVC or RA/SVC? If it's back at a curve it could easily be up against the vein wall. (which also means you are giving the TPN against the vein wall)

What size is the catheter? Hopefully the doc put in an adequate size!

I assume you had the person do all the usual things like cough, turn head, change arm position, go for a walk etc?

And, obviously, if a Groshong Valved line that it was flushed before trying blood withdrawal?

Was flouro done to check for a fibrin sheath? Often a tPa infusion is necessary, not intralumen tPa.

I've also had the conversation with a surgeon, who tried to say that ports weren't meant to show blood back and that chemo should be given anyway....'cause he says so! A different doc was getting annoyed with calls re no blood back and admitted that he put "a baby size" in the pt with tip @ carina because he hadn't realized the pt needed blood drawn! He totally missed the point that pt was receiving a CVC as he had terrible peripheral access.

[PICC ACE]

What did the person mean who said "the line closes in on itself"?? Did the patient get a chest xray to confirm proper placement or a dye study to check catheter integrity? Lines can migrate out of position for a number of reasons,or not be placed correctly in the first place,or they can get damaged and these problems can lead to lack of blood return. There are some scary things that have happened to patients whose devices were either improperly placed or damaged (like TPN into the pleural space from an improperly-placed CVC or Adriamycin into the subcutaneous tissue from a port that had a leaking catheter).

BTW,are you familiar with the Royal College of Nursing's Standards for Infusion Therapy? Just curious...